Medicare requires doctors who participate in the program to file claims on behalf of their patients. Medicare Advantage plans do not fall under the same rules because they are run by private companies and the government pays them a set amount to handle the cases each month. A person with an advantage plan may need to file a claim with his insurance company from time to time, but he does not ever need to file one with Medicare. Although a beneficiary does not usually have to file a claim, there are circumstances when paperwork gets lost or a busy doctor’s office becomes forgetful. In this rare circumstance, a person does have to file a claim.
Filing a Medicare claim is not a pleasant process, but it is not a difficult one either. A beneficiary must obtain the appropriate form from Medicare. He can download the form in PDF format from Medicare.gov or find the form in paper format at the social security office that serves his region. The form requires a lot of details and a person has a limited amount of time to fill it out. A claim, when it has to be made, can only be made within one year from the original date of service.
If a patient fails to file a Medicare claim that a doctor forgot or missed within the required time frame, he must pay for the service out of his own pocket. Filing a claim with Medicare is not enough, however, the claim must go through a review board and can still be denied. If a claim gets denied and the patient feels it is a valid service, he can appeal the board’s decision.